Exploring impaired decision-making as a functional deficit in adults with ADHD

Home | Exploring impaired decision-making as a functional deficit in adults with ADHD

29 Mar 2015

Mowinckel AM et al. J Atten Disord 2015; 19: 355-367.

Adults with ADHD may have decision-making* deficits of similar magnitude to their attention deficits, a recent meta-analysis reports.

Risky decision-making, reinforcement learning and temporal discounting (delayed reward decision-making)† – sub-domains of overall decision-making – have been associated with ADHD. This study explored emerging research into reward-based decision-making in adults with ADHD using 59 published studies.† Furthermore, researchers attempted to contextualise these findings by comparing the effect sizes of different decision-making sub-domains (assessed by various tasks) with effect sizes of attention deficits (assessed by the continuous performance task [CPT])‡ in adults with ADHD.

Findings support the existence of decision-making deficits in adults with ADHD, which are of similar small-to-medium effect size as attention deficits (g=0.551 vs g=0.410, respectively). When the sub-domain of reinforced learning was considered, a medium difference was observed between adults with ADHD and healthy controls (g=0.551) indicating that adults with ADHD make less advantageous choices. However, risky decision-making was found to have a small effect size (g=0.226); and perhaps unexpectedly, delayed reward decision-making was also found to have little effect (g=0.140), although this may be a result of the small number of studies available.

The findings of this meta-analysis suggest that when compared with healthy controls, adults with ADHD have decision-making deficits of similar magnitude to their attention deficits. As research into the field of decision-making as a deficit in ADHD is currently limited, these findings therefore support the further examination of decision-making in adults with ADHD to improve understanding of the underlying neurocognitive mechanisms.

g = Hedge’s g; measure of effect size
*Decision-making: any process leading to an action where one of several decision alternatives is selected†Temporal discounting (delayed reward decision making): tendency to give greater value to rewards the closer they are to being received/gained‡CPT: a computerised test of attention and vigilance, used clinically and in research